基于Joinpoint回归及年龄-时期-队列模型分析鼻咽癌患者的死亡率发展趋势

目的 探讨1990～2019年我国鼻咽癌患者的死亡率长期发展趋势。方法 数据来源于GHDx数据库,采用Joinpoint回归模型分析我国鼻咽癌患者死亡率趋势进行阶段性分析,并利用年龄-时期-队列模型进一步估计我国鼻咽癌患者死亡风险的年龄效应、时期效应和队列效应。结果 1990～2019年我国鼻咽癌患者死亡率呈逐年下降趋势,整体变化趋势划分为五段,AAPC值为-2.454%。男性鼻咽癌患者死亡率变化趋势划分为五段,AAPC值为-1.958%;女性鼻咽癌患者死亡率变化趋势划分为六段,AAPC值为-3.498%。随着年龄的增长,鼻咽癌患者死亡率的年龄效应明显增加,并且死亡率的周期效应总体呈上升趋势。结论 队列效应的降低可能导致癌症死亡率的降低,而年龄效应和周期效应的增加可能导致癌症患者的死亡率增加。     

鼻咽癌研究进展

鼻咽癌有很多分化类型,常见于咽隐窝,位于咽鼓管咽口内侧角的后内侧壁。这种恶性肿瘤在大多数国家发病率较低,不到1/10万人。但在中国南部,非洲北部和阿拉斯加州,其发病率却很高,尤其多见于阿拉斯加州的因纽特人和中国广东人。有报道在香港鼻咽癌的发病率男女各为20～30/10万和15～20/10万。侨居于东南亚和美国北部的中国人发病率仍然维持在较高的水平,但在美国北部出生的中国人发病率明显低于出生在中国南部的人群。这些发现表明基因、人种和环境因素等可能均在鼻咽癌的发病中起到一定作用。1病理学鼻咽癌的恶性上皮细胞大都是大的多角形细…     

鼻咽癌的基础研究

据Lo等[1]报道2000年全球初诊的65000例鼻咽癌（nasopharyngeal carcinoma,NPC）中约80%的病例发生在中国及东南亚诸国,中国的南方发病率高于北方,以广东、广西、福建、湖南等省发病率最高,可达到30/10万～50/10万,在西方发达国家极为少见,     

广东省中山市东区中山籍鼻咽癌发病和死亡率动态分析

目的调查2002~2013年中山市东区中山籍鼻咽癌发病和死亡率。方法通过中山市内肿瘤登记处、三甲医院、东区公安分局收集2002~2013年东区全部中山籍鼻咽癌名单和中山籍居民资料统计分析,并与其他地区比较。结果 2002~2013年东区中山籍男、女性鼻咽癌粗发病率分别是44.66/105和25.30/105,粗死亡率分别是17.21/105和9.12/105;12年间,东区中山籍男、女性鼻咽癌每年粗发病率分别在36.75/105~48.06/105和20.33/105~30.70/105之间波动,粗死亡率分别是12.25/105~21.66/105和4.86/105~12.05/105之间波动。结论中山籍居民既是目前全世界鼻咽癌发病率最高的人种,也是死亡率最高的人种之一;鼻咽癌死亡率下降不代表鼻咽癌发病率下降。     

脑卒中后言语障碍康复治疗研究进展

脑卒中是一组由于脑部血管突发破裂或阻塞导致血液不能流入大脑而引起脑组织损伤的急性脑血管疾病[1],近年来脑卒中成为导致残疾、死亡的主要原因之一[2~4],具有高患病率、高发病率及高死亡率的特点。有学者曾对中国31个省总计480687例20岁以上的成年人进行调查,结果显示一年内脑卒中的患病率、发病率和死亡率达到1114.8/10万、246.8/10万和114.8/10万[5]。Brady[6]研究发现脑卒中患者的障碍问题不仅局限于躯体障碍,其言语问题也使患者的社会交流和生存质量遭到严重影响。     

大唾液腺含有淋巴样基质的未分化癌

唾液腺的恶性肿瘤在人类全部肿瘤中还不到1%,其发病率每年约为0.2人/10万人;而格陵兰地区的腮腺肿瘤中则有60%以上属恶性肿瘤,高出世界其它地区2～3倍(男性年发病率3.9/10万人,女性7.7人/10万人)。有90%发生在腮腺部位,其中90%为含有淋巴样基质的未分化癌。居住在加拿大的爱斯基摩人的唾液腺的恶性肿瘤的发病率比估计的要高30多倍。其中大多数为含有淋巴样基质的未分化癌,在报告的病例中3/4为格陵兰土著人,北美爱斯基摩人和中国南方人(香港地区),均属蒙古人种。但是在香港人中,大唾液腺癌     

甲状腺癌外科治疗

甲状腺癌(thyroid carcinoma,TC)约占人体恶性肿瘤的1%,发病率约1～3/10万,占肿瘤致死总数的0.5%,死亡率约11%～17%。其侵犯喉、气管的概率为1%～13%,死亡率达86%。目前国内、外对甲状腺癌的外科治疗得到迅速发展,本文就其外科治疗现状综述如下。目的在于探讨甲状腺癌的治疗手段,同时展望其治疗前景。     

甲状腺癌外科治疗

甲状腺癌（thyroid carcinoma,TC）约占人体恶性肿瘤的1%,发病率约1～3/10万,占肿瘤致死总数的0.5%,死亡率约11%～17%。其侵犯喉、气管的概率为1%～13%,死亡率达86%。目前国内、外对甲状腺癌的外科治疗得到迅速发展,本文就其外科治疗现状综述如下。目的在于探讨甲状腺癌的治疗手段,同时展望其治疗前景。     

甲状腺乳头状癌原发灶手术范围的现状及研究

甲状腺癌是最为常见的甲状腺恶性肿瘤,占全身恶性肿瘤的1.0%～1.5%,近年来随着医疗水平的不断提高,甲状腺癌的发病率呈明显上升趋势.据美国肿瘤中心的统计报道[1],预计2007年美国新增甲状腺癌患者约33 550例,1 530例患者将因甲状腺癌死亡,目前在美国,甲状腺癌已成为女性恶性肿瘤排位中的第7位.我国上海市疾病预防控制中心2004年统计资料显示,甲状腺癌年发病率为:男性3.71/10万,女性10.49/10万,较2003年明显增长[2].最常见的病理类型为乳头状癌,约占60%～80%.     

喉部分切除术及发声效果观察

1 概述 喉癌是头颈部常见的恶性肿瘤之一,占全身恶性肿瘤的0.87%～7.3%,位于第16～19位,占耳鼻咽喉科恶性肿瘤的7.9%～35%.喉癌的流行病学各国和各地区的统计结果各不相同.文献报道世界三大高发区是:巴西的圣保罗,意大利的瓦雷泽和印度的孟买,发病率分别为17.1/10万,15.5/10万和15.5/10万.喉癌男性较女性多见,约为7～10:1,喉部恶性肿瘤中约95%～98%为鳞状细胞癌,其他如腺癌,基底细胞癌,低分化癌等[1].     

Incidence and survival rates for young blacks with nasopharyngeal carcinoma in the United States

OBJECTIVES: To compare the incidence rates of nasopharyngeal carcinoma (NPC) among US black, white, and Asian/Pacific Islander (Asian) populations, with a focus on those diagnosed before age 20 years and between ages 20 and 29 years. Our secondary objective was to determine differences in survival rates between US blacks, whites, and Asians with NPC who were younger than 30 years. DESIGN: Data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) tumor registry system were used to determine incidence and survival rates for cases of NPC diagnosed in the specified age groups between 1973 and 2002. PATIENTS: Blacks, whites, and Asians younger than 30 years with NPC. MAIN OUTCOME MEASURES: Incidence rates and 2- and 5-year survival rates. RESULTS: From 1973 to 2002, incidence rates per 1 million persons, adjusted to the 2000 standard population, for blacks, whites, and Asians younger than 20 years with NPC were 1.61 (n=43), 0.61 (n=99), and 0.95 (n=18), respectively. The incidence rate ratio of blacks to Asians younger than 20 years was 1.69 (95% confidence interval [CI], 0.96-3.12) (P=.07), while the rate ratio for blacks to whites was 2.66 (95% CI, 1.82-3.85) (P<.001). From ages 20 to 29 years, rates increased slightly in blacks (1.87) and whites (0.96), while increasing dramatically in Asians (7.18). Two- and 5-year relative survival rates in blacks younger than 30 years were 84% and 64%, respectively, with little variation between races in this age group. CONCLUSIONS: Blacks younger than 20 years have increased incidence rates of NPC relative to whites and may be the only group having a higher NPC incidence rate than Asians. Two- and 5-year survival rates of blacks, whites, and Asians younger than 30 years with NPC are similar.     

鼻咽癌放疗后并发鼻窦炎

目的 探讨鼻咽癌患者在放射治疗后鼻窦炎的发生、发展及其影响因素.方法 回顾性分析蚌埠医学院第一附属医院2000年～2005年256例鼻咽癌患者资料,通过比较放疗前、后鼻咽部CT,总结放疗前无鼻窦炎症状而放疗后发生鼻窦炎的情况.结果 放疗前鼻窦炎发生率为43.8％ (112/256),放疗前无鼻窦炎症状而放疗后出现鼻窦炎...     

基质金属蛋白酶-1（-1607）1G/2G基因多态性与鼻咽癌相关性研究

目的研究基质金属蛋白酶-1（matri xmetalloproteinases-1,MMP-1）（-1607）1G/2G基因单核苷酸多态性与云南汉族鼻咽癌发病风险、各临床参数及预后相关性。方法按病例对照研究,利用聚合酶链反应-限制性片段长度多态性（restriction fragment lengthpolymorphism-PCR,RFLP-PCR）,对241例云南籍汉族鼻咽癌患者和272例云南籍汉族健康对照进行基因分型,分析基因型与云南汉族鼻咽癌发病风险及预后关系。结果分别携带1G2G、2G2G基因型个体罹患鼻咽癌风险性是携带1G1G基因型者3.10倍和9.93倍;2G等位基因与T分期、颈淋巴结转移、临床分期明显相关（P〈0.05）。吸烟与MMP-1（-1607）2G等位基因存在相加交互作用;MMP-12G等位基因与患者预后不良相关,且2G2G基因型为独立预后影响因素。结论MMP-1（-1607）1G/2G多态性是云南汉族鼻咽癌遗传易感因素,与吸烟暴露呈现交互作用,同时与鼻咽癌预后相关。     

Epidemiological features of cancers of the oral cavity,oropharynx, hypopharynx and larynx cancer in Réunion Island

IntroductionThis study had two objectives: firstly, to identify and compare characteristics of cancer of the oral cavity, oropharynx, hypopharynx and larynx in Réunion Island, a tropical French overseas territory in the southern hemisphere; and secondly, to discuss how incidence of these cancers is presented in the international literature.Material and methodA retrospective study included 599 patients diagnosed with cancer of the oral cavity, oropharynx, hypopharynx or larynx between 2009 and 2013 in Réunion Island. Demographic characteristics and data on alcohol consumption, smoking habits and HPV infection were analyzed. Standardized incidences were calculated for the worldwide population for both genders.ResultsSex ratio was 7.7 and mean age was 60 years. Cancer consisted of squamous cell carcinoma in 99.1% of patients. Three hundred and forty over 375 patients (81.25%) showed alcohol abuse; 309/359 (86.1%) were smokers; 31/184 (16%) had HPV infection. On the International Agency for Research on Cancer (IARC) anatomic classification, the incidence of “other pharynx” locations was 9.3/100,000 for men and 0.7/100,000 for women, and incidence of “larynx” locations was 6.4/100,000 for men and 0.4/100,000 for women.ConclusionRéunion Island features some particularities in terms of incidence: women are less than half as likely as in Metropolitan France to develop any type of cancer, whereas incidence in males is among highest in France. The presentation of results in cancer registries could be improved in line with everyday practice in head and neck surgery.     

鼻咽癌组织中PI3K、mTOR的表达及临床意义

目的研究鼻咽癌组织中磷脂酰肌醇3-激酶(phosphoinositide 3-kinase,PI3K)、哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin,mTOR)的表达及其临床意义。方法采用免疫组化方法检测PI3K、mTOR在47例鼻咽癌和20例鼻息肉组织中的表达,回顾性研究表达与TNM分期、浸润、转移的关系。结果①鼻咽癌组及鼻息肉组中PI3K的阳性表达率分别为76.6%(36/47)、35.0%(7/20),mTOR分别为70.2%(33/47)、25.0%(5/20),差异均有统计学意义(χ2=12.36,χ2=11.6,P均<0.05);②鼻咽癌组织中,角化型鳞状细胞癌组与非角化型鳞状细胞癌组PI3K的阳性表达率分别为65.0%、85.1%,差异无统计学意义(χ2=2.61,P>0.05),mTOR分别为55.0%、81.5%,差异有统计学意义(χ2=3.85,P<0.05),I期+II期、III期+IV期组中PI3K的阳性表达率分别为80.0%、72.7%,mTOR为72.0%、68.2%,差异均无统计学意义(χ2=0.35,χ2=0.08,P均>0.05)。有无淋巴结转移组中PI3K的阳性表达率分别为70.0%、88.2%,mTOR为76.7%、58.8%,差异均无统计学意义(χ2=2.91,χ2=1.65,P均>0.05)。结论 PI3K及mTOR在鼻咽癌发生发展中起一定作用,mTOR与鼻咽癌的病理分型有相关性。     

Neoadjuvant chemotherapy plus intensity-modulated radiotherapy versus neoadjuvant chemotherapy plus concurrent chemoradiotherapy for ascending or descending types of nasopharyngeal carcinoma: A retrospective study

PurposeThis study aimed to compare the efficacy between neoadjuvant chemotherapy (NACT) plus intensity-modulated radiotherapy (IMRT) and NACT plus concurrent chemoradiotherapy (CCRT) in patients with nasopharyngeal carcinoma (NPC).Materials and methodsData from 603 patients with ascending (T4 and N0–1) or descending (T1–2&N3) NPC who were treated at Sun Yat-sen University Cancer Center between October 2009 and February 2012 were retrospectively analyzed. These patients were divided into two groups: NACT+IMRT (n = 302) and NACT+CCRT (n = 301). The primary endpoint was overall survival (OS), which was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards model, and landmark analysis.ResultsIn univariate analysis, there was no significant difference in 5-year OS between the NACT+IMRT and NACT+CCRT groups (hazard ration [HR]: 0.69; 95% confidence interval [CI]: 0.47–1.01; P = 0.057). However, after adjustment for age (<45 years, ≥45 years), gender, histological stage (I/II, III), T stage (1/2, 3, 4), and N stage (0/1, 2/3), NACT+IMRT was more effective in improving OS, with a 33% decrease in the risk of death than NACT+CCRT (HR: 0.67; 95%CI: 0.45–0.99). Furthermore, landmark analysis indicated that patients in the NACT+IMRT group had higher OS rates within 24 months (HR: 1.83; 95%CI: 1.00–3.34), whereas those treated with NACT+CCRT had higher OS rates after 24 months (HR, 0.47; 95% CI, 0.29–0.77). We also found significant survival benefits of NACT+IMRT regimen in patients younger than 45 years old (HR: 0.27; 95%CI: 0.14–0.49), and in those at stage T3 (HR: 0.50; 95%CI: 0.27–0.93) and stage N2/3 (HR: 0.52; 95%CI: 0.32–0.83).ConclusionPatients with ascending or descending NPC who are treated with NACT+IMRT may have better long-term survival outcomes than those treated with NACT+CCRT, especially the patients younger than 45 years old or in stage T3/N2/N3. Additionally, NACT+IMRT may be a better option than NACT+CCRT in patients within the first 24 months.     

p15和p27蛋白在鼻咽癌中的表达及其相关意义

目的研究周期素依赖激酶蛋白质类p15和p27蛋白在鼻咽癌（nasopharyngeal carcinoma,NPC）组织中的表达,探讨它们之间的关系与NPC生物学行为及预后的相关性。方法应用免疫组织化学EnVision两步法检测43例NPC组织和21例鼻咽黏膜慢性炎症组织,即非癌鼻咽组织（non-tumor nasopharyngeal,NP）中p15和p27表达水平。结果①NPC组织中p15和p27阳性表达率分别为65.1%和69.7%,与NP组比较,差异有统计学意义（P〈0.05）;②p15和p27蛋白在NPC中的表达与NPC临床分期、淋巴结转移、脑神经侵犯及治疗后5年生存率无关（P〉0.05）;③p15、p27阳性表达之间有相关性（P〈0.05）。结论p15蛋白和p27蛋白的表达缺失对NPC的发生起一定作用。     

鼻咽癌治疗前后EB病毒DNA载量的动态观察及其临床意义

目的：通过研究鼻咽癌患者血浆EBVDNA载量预测复发及远处转移的发生,为个体化治疗提供分子学指标。方法：对54例初治鼻咽癌患者分别在治疗前和治疗结束时采用荧光定量PCR方法检测血浆EBVDNA载量,并对所有患者进行随访复查,评价其远期疗效,计算无进展生存率及总生存率。结果：所有患者治疗前血浆EBVDNA载量能较好地反映患者的临床特征;远处转移者治疗前血浆EBVDNA载量及治疗后EBVDNA检出率均高于持续缓解者（均P〈0．05）;以治疗前20000copies／ml为界限,EBVDNA低载量患者的无进展生存率、总生存率均高于高载量患者（P〈0．01和P〈0．05）。结论：鼻咽癌患者治疗前血浆EBVDNA载量能一定程度地预测远处转移的发生。     

Changing trends in the occurrence and subsite distribution of laryngeal cancer in Finland

Cancer of the larynx represents worldwide approximately 1–2% of all cancers and generally occurs predominantly in males. Based upon many reports, the age-adjusted incidence of laryngeal cancer has been rising in recent years, especially among women. Squamous cell carcinomas arising in the glottic region are the most common of all laryngeal cancers and more prevalent than the supraglottic ones. Subglottic disease is still rare. The Finnish Head and Neck Oncology Group evaluated the present occurrence of laryngeal cancer by site and gender in Finland. The annual age-standardized incidence of laryngeal cancer is 3.2 per 100,000 for men and 0.3 per 100,000 for women. The proportion of females in the five university centers reviewed was 5%. During the 30-year time period from the early 1960s to the 1990s there has been a significant decrease in the laryngeal cancer incidence rates for males, but no change for females. Finland thus seems to be the only Western country with clearly declining occurrence rates in recent decades. In the same time period a clear decrease in the incidence of bronchial cancer has occurred in males and an increase in females. The results also show that in all five university hospital districts glottic cancer became more common (50–68%) in the late 1980s and 1990s, which is opposite to the situation in the 1960s when supraglottic localizations (65%) dominated in Finland. Received: 26 September 1998 / Accepted: 27 January 1999     

鼻咽癌放化疗局部失败的相关因素分析

目的：探讨鼻咽癌放化疗后局部失败（残留或复发）的相关影响因素。方法：对308例鼻咽部原发癌患者的临床病理资料进行回顾分析。选择性别、年龄、T分级、N分级、原发癌病理类型、有无颈淋巴结转移、颈转移淋巴结大小、颈淋巴结转移侧数、颈淋巴结转移累及区域、放疗方法、有无同步化疗等临床病理因素,用x^2检验和Logistic回归进行单因素和多因素分析,并用Kaplan-Meier法对残留和复发患者进行生存分析。结果：在308例头颈部原发鳞状细胞癌患者中,93例（30．2％）发生原发灶和颈部的残留或复发。单因素分析显示,T分级（P〈0.01）、N分级（P〈0.01）、有无颈淋巴结转移（P〈0.05）、颈转移淋巴结大小（P〈0.05）、颈淋巴结转移侧数（P〈0.01）与残留或复发有关。多因素分析结果表明,仅T分级与残留或复发明显相关。用Kaplan-Meier法进行生存分析显示71例残留或复发患者再次治疗的1年、3年、5年生存率分别为77．2％、40．4％、22．4％。结论：原发癌T分级是鼻咽癌治疗局部失败的决定性因素。而有无颈淋巴结转移、原发癌N分级、颈淋巴结转移侧数、颈淋巴结大小是影响因素和T分级的协同因素,但不是导致残留和复发的的初始和根本因素。鼻咽癌侵犯骨时易导致治疗失败。治疗失败者经再次治疗可以提高生存率。